Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience

Konstantinos Pikramenos; Maria Zachou; Dimitrios Papadopoulos; Athanasios Papatsoris; Ioannis Varkarakis; Iraklis Mitsogiannis

doi:10.7759/cureus.34601

Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience

Cureus. 2023 Feb 3;15(2):e34601. doi: 10.7759/cureus.34601. eCollection 2023 Feb.

Authors

Konstantinos Pikramenos¹, Maria Zachou^{2

3}, Dimitrios Papadopoulos⁴, Athanasios Papatsoris¹, Ioannis Varkarakis¹, Iraklis Mitsogiannis¹

Affiliations

¹ Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, GRC.
² Gastroenterology, National and Kapodistrian University of Athens, Athens, GRC.
³ Gastroenterology, Sismanoglio General Hospital, Athens, GRC.
⁴ Anaesthesiology, Evgenidio Hospital, National and Kapodistrian University of Athens, Athens, GRC.

Abstract

Introduction: This study aims to determine the effects of radical retropubic prostatectomy on post-operative erectile function.

Materials & methods: A total of 50 patients were included in this study, diagnosed with localized prostate cancer, and underwent nerve-sparing radical retropubic prostatectomy. All patients completed the International Index of Erectile Function (IIEF-5) questionnaire pre-operatively and on the third, sixth, and twelfth post-operative month and completed a self-reporting of their satisfaction with their sexual performance. Patients with a history of severe heart disease, were on erectile dysfunction medication, or had a score of 7 or less on the IIEF-5 questionnaire, were excluded from the study.

Results: Pre-operatively it was observed that the lower the IIEF-5 score, the higher the biopsy Gleason score. Post-operatively, 16 patients stated that erectile function had returned to the pre-operative IIEF-5 category. In contrast, only 13 of them stated they were happy with their sexual performance on the self-reporting scale. The rest reported dissatisfaction despite returning to their pre-operative erectile function status. IIEF-5 scores were also different when compared amongst the four age groups, with scores indicating that younger age is related to higher IIEF-5 scores. At the 3-month follow-up, no statistically significant difference was observed between age groups. Finally, patients younger than 64 reported significantly less deterioration in post-operative erectile function.

Conclusion: Post-radical prostatectomy erectile dysfunction remains one of the most pressing issues in prostate cancer therapy. A higher Gleason score has a more significant impact on pre-operative ED, and at the same time, the best post-operative ED results are observed in younger patients. Finally, patients need extensive follow-up, therapy, and pre-and post-operative psychological support to have the best possible erectile function.

Keywords: complications; erectile dysfunction; prostate cancer; radical prostatectomy; urologic oncology.